Thanks to fantastic medical advances, we are lucky to live in an age and place where HIV means something different than it used to. But with advances, new questions arise. How do we keep ourselves and our community healthy and happy? What wonders will stir our souls and what demons lurk?
Here are ten things, in no particular order, that I think about every day at work. This is not meant to be an exhaustive list and not everything here may pertain to every gay man. Hopefully, though, at least a few of the things on this list have some relevance to you, your friends or family.
1. Pre-exposure prophylaxis (PrEP): a pill a day to prevent HIV. We currently have medications that have been shown to help treat HIV. We are now exploring the idea of using one of those medications to help keep people from getting HIV. If the pill does help prevent HIV infections and gets approved for use, then new questions will emerge. Who should get it, who would pay for it, and how will it affect sexual norms?
2. Who is getting HIV and why? Well, we know more than a million people in the United States have HIV. Twenty percent of them don’t know it. About half of Americans infected with HIV are men who have sex with men (MSM) and most of them got HIV from unprotected anal sex.
Black MSM in the United States have especially high rates of HIV infection. Why? Are Black MSM more risky? Research tells us this isn’t the case. The stigma surrounding HIV and gay and bisexual men in communities of color remains strong and HIV prevention services are often inadequate. This stigma and inequality has allowed HIV to become entrenched in some communities. This requires action.
3. Hepatitis C is likely more sexually transmissible than originally thought and is easily spread while sharing needles during injection drug use. Hep C co-infection with HIV can create a very complicated situation.
4. Rapid viral load testing for HIV may become a reality in the next few years. Viral load testing looks for HIV itself in blood versus looking for HIV antibodies. Viral load testing virtually eliminates the “window” period between HIV exposure and an accurate HIV test result since it can take a period of weeks or months for detectable antibodies to be produced. Cheap and easy viral load testing may change the way we conduct HIV testing. How will this affect behavior and beliefs?
5. Fewer participants in the acupuncture detoxification program at Fenway Health are reporting crystal meth use as their primary drug of concern. This may indicate that the popularity of the drug may be waning and/or its use has been driven partially underground. Regardless, crystal meth use is a serious problem and it is something we should keep our eye on.
6. There is a belief that HIV positive people on meds and with well-controlled viral loads may not be particularly infectious. Although some research indicates that this can reduce new infections, it remains important that we not allow social beliefs around safer-sex practices to become distorted. HIV can potentially be passed from one person to another unless basic, simple precautions are upheld, such as consistent condom use during sexual intercourse and not sharing needles during injection drug use.
7. Gardisil, a vaccine that protects against several strains of human papillomavirus (HPV), has recently received FDA approval for use in men. This is a good thing because some types of HPV can cause anal or genital warts, while other types may eventually lead to anal and throat cancers. The vaccine is a powerful tool in biomedical prevention and its promotion has raised awareness about HPV.
8. Research on a variety of HIV prevention technologies is critical. HIV vaccine research marches on and we are also researching “microbicides,” types of lubes and jellies used during sex that can help fight HIV. In time, microbicides may prove effective in preventing HIV. Someday, perhaps a “stacked” approach will prevail. Maybe a vaccine in combination with microbicides, things like PrEP and more traditional HIV prevention techniques will nearly eliminate the transmission of HIV. How and when these emergent technologies will impact us is unknown but participation in clinical research trials is a productive contribution to the community that could lead to a healthier future for everyone.
9. We should consider if informed consents for HIV testing are a potential barrier to getting an HIV test. An informed consent is basically a special document that someone needs to sign before they can get their test. We don’t use these for most other medical tests, so one might wonder why we still have them for HIV testing. CDC recommends that HIV testing become a routine practice. The more people know their status, the better.
10. We must continue to advocate for local, State and federal attention to important community issues such as HIV, health disparities, poverty, drugs, and violence. A call for equal rights and recognition should include a call to end anti-LGBT violence, support recovery, contain HIV, and end discrimination in health care, housing and employment.